The goal of the proposed research is to determine the neurobehavioral and physical health outcomes of the offspring of individuals affected by Fetal Alcohol Spectrum Disorders (FASD). The teratogenic effects of prenatal alcohol exposure (PAE) are well established in children and young adults and include neurocognitive deficits, impairments in adaptive and social functioning, and psychiatric disorders but limited data exists regarding their adult outcomes, including their parenting abilities. Systematic studies on the impact of PAE on second generation offspring are lacking despite preclinical models suggesting the possibility of multigenerational effects. This proposal is a supplement to Dr. Coles? UO1 grant (AA 026108), which is currently investigating the physical, mental and social health outcomes of a cohort of midlife adults, who were identified at birth as prenatally exposed to alcohol, and periodically assessed throughout their lifespan. Preliminary data from this investigation shows that adults affected by PAE have persistent impairments in adaptive and social functioning, and poorer mental and physical health than unexposed controls. Many adults in this sample now have children of their own but it is unknown how the associated impairments in functioning impacts their offspring, who are likely a vulnerable population with unrecognized needs and challenges. The investigators and resources of the FASD adult follow-up study provide a unique opportunity to study the multigenerational consequences of PAE. This proposal has three aims: (1) to assess the neurobehavioral and physical health status of the offspring of adults with FASD, including prevalence of psychiatric problems, aspects of neurocognitive and adaptive functioning, and prevalence of FASD; (2) to identify parental determinants of health and disease in children of individuals with FASD; and (3) to determine the impact of environmental factors, including adverse childhood experiences (ACES), on the health outcomes in offspring of FASD-affected individuals. The sample will include 60 offspring aged 5-17 years of adults who are either the offspring of the adults with FASD (n=30) or the unexposed controls (n=30). We anticipate greater rates of FASD and increased severity of neurobehavioral problems, psychiatric symptomatology and health problems in children of adults with an FASD. We also predict that the psychiatric, neurocognitive and adaptive functioning in FASD-affected individuals will be predictive of these symptoms in their offspring and that parenting styles, socioeconomic status and ACES will mediate these relationships. Accurate information on the health outcomes of the offspring of FASD-affected individuals will allow for informed decision-making by policy makers, caregivers, and health care workers.